Issue: 2017 > July > photo quiz

Answer to Photo Quiz: Invalidating painful foot

Full textPDF

Full text


Based on the symptoms and the results of MRI and bone scan this fits best with transient osteoporosis of the intermediate cuneiform bone, also known as bone marrow oedema syndrome.
Transient osteoporosis is an uncommon syndrome of unknown aetiology, characterised by self-limiting pain and obvious focal osteopenia and oedema on imaging, visible within eight weeks after the onset of the pain. The diagnosis is made by exclusion based on MRI and is often delayed because of the low prevalence and nonspecific signs.1 It is best described in the hip among women in the last trimester of pregnancy and middle-aged men. Painful symptoms gradually subside and reach full recovery without intervention within 18 months.
Because transient osteoporosis resolves on its own, treatment focuses on minimising the symptoms and preventing any damage to the bones while they are weakened by the disorder. Our patient is being treated according to complex regional pain syndrome protocol,2 with dimethyl sulfoxide cream which inhibits the impulse conduction in peripheral sensory nerves, in combination with acetylcysteine for combating free radicals that might be associated with the onset of complex regional pain syndrome on the basis of a sterile inflammation. Bone strength will return to normal.


Transient osteoporosis of the intermediate cuneiform bone with complex regional pain syndrome.


  1. Mirghasemi SA, Trepman E, Sadeghi MS, Rahimi N, Rashidinia S. Bone Marrow Edema Syndrome in the Foot and Ankle. Foot Ankle Int. 2016;37:1364-73. 
  2. Bruehl S. Complex regional pain syndrome. BMJ. 2015;351:h2730.